目的: 探讨甲胎蛋白(AFP)和甲胎蛋白异质体(AFP-L3)在原发性肝癌(PHC)诊断中的应用价值。方法: 收集256例血清标本,其中原发性肝癌(PHC)患者91例(原发性肝癌组)、肝硬化患者96例(肝硬化组)、慢性活动性肝炎患者69例(慢性肝炎组)、正常健康人群对照70例。检测AFP和 AFP-L3采用化学发光法。结果:AFP、AFP-L3在PHC组的浓度水平和阳性率与肝硬化组、慢性肝炎组和正常组比较差异有统计学意义(p <0.05)。AFP和AFP-L3水平和阳性率在肝良性疾病组比较差异无统计学意义。单独检测AFP、AFP-L3灵敏度分别为74.43%、77.18%,特异性分别为45.45%、80.61%,联合检测灵敏度、特异性分别为79.12%和70.91%,AFP-L3灵敏度和特异性优于AFP, 灵敏度虽低于联合检测,但相差不大,特异性明显高于联合检测。结论: AFP-L3检测可显著提高原发性肝癌诊断的灵敏度和特异性,对原发性肝癌的的筛查诊断具有重要意义。
[1] 中国抗癌协会肝癌专业委员会原发性肝癌的临床诊断与分期标准[J]. 中华肝脏病杂志, 2001,9(6):324
[2]Sato Y, Nakata K, Kato Y, et al. Early recognition of hepatocellular carcinoma based on altered profiles of alpha-fetoprotein[J]. N Engl J Med, 1993,328(25):1802
[3]吴晓霞,邓俊,姚悦萍,等. 血清甲胎蛋白异质体对肝细胞癌的诊断意义[J]. 实用肝脏病杂志, 2011,14(4):300
[4]Okuda H, Saito A, Shiratori K, et al. Clinicopathologic features of patients with hepatocelluar carcinoma seropositive for alpha-fetoprotein-L3 and seronegative for des-gamma-carboxy prothrombin in comparison with those seropositive for des–gamma–carboxy prothrombin alone[J]. J Gastroenterol Hepatol, 2005,20(5):759
[5]Matsuda M, Asakawa M, Amemiya H, et al. Lens culinaris agglutinin-reactive fraction of AFP is a useful prognostic biomarker for survival after repeat herpatic resection for HCC[J]. J Gastroenterol Hepatol, 2011,26(4):731
[6]陈建文. 亲和层析结合酶联免疫定量检测甲胎蛋白异质体[J]. 中国误诊学杂志, 2009,9(13):3117
[7]蒋英,谢延,宫贺,等. AFP-L3在肝细胞癌早期诊断中的应用价值研究[J]. 中国热带医学, 2009,9(2):292
[8]Oka H, Saito A, Ito K, et al. Multicenter prospective analysis of newly diagnosed hepatocellular carcinoma with respect to the percentage of lens culinaris agglutinin–reactive alpha-fetoprotein[J]. J Gastroenterol Hepatol, 2001,16(12):3178
[9]Sterling R K, Jeffers L. Utility of lens culinaris agglutinin-reactive fraction of alpha-fetoprotein and des-gamma-carboxy prothrombin,alone or in combination,as biomarkers for hepatocellular carcinoma[J]. Clin Gastroenterol Hepatol, 2009,7(1):104
[10]殷正丰. 甲胎蛋白异质体作为肝癌标志物的临床应用[J]. 实用肿瘤杂志, 2004,19(1):1
[11]屠振兴,吴孟超,崔贞福. 甲胎蛋白异质体对原发性肝癌早期诊断的研究[J]. 第二军医大学学报, 1985,4(4):193
[12]郑颖,单晓洁,任茗睿,等. 微量离心柱法检测甲胎蛋白异质体对原发性肝癌诊断的意义[J]. 浙江实用医学, 2009,14(1):3
[13]胡敏华,陈燕,粱亚嘉,等. 新微量离G柱法测定甲胎蛋白异质体对原发性肝癌诊断的价值田[J]. 福建医药杂志, 2009,31(4):95
[14]熊彪,蔡其浩,蒙凯. 三项生化指标联合甲胎蛋白诊断原发性肝癌的研究[J]. 当代医学, 2008,14(17):37
[15]ter V E, Heijmen L, van Laarhoven H W, et al. In ViVo magnctic resonance Spectroscope ofliver tumors and metastase[J]. World J Gastroenterol, 2011,17(47):5133
[1]韩 悦,魏殿军.miR-202、AFP及DKK1在原发性肝癌患者血清中的表达及其意义[J].天津医科大学学报,2018,24(06):517.
HAN Yue,WEI Dian-jun.Expression and significance of miR-202, AFP and DKK1 in serum of patients with primary hepatic carcinoma[J].Journal of Tianjin Medical University,2018,24(06):517.